From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm; the Department of Forensic Psychiatry, University of Eastern Finland, and Niuvanniemi Hospital, Kuopio; the Impact Assessment Unit, National Institute for Health and Welfare, Helsinki; and the School of Pharmacy, University of Eastern Finland, Kuopio.
Am J Psychiatry. 2018 Aug 1;175(8):765-773. doi: 10.1176/appi.ajp.2018.17091001. Epub 2018 Apr 6.
It is generally believed that after the first episode of schizophrenia, the risk of relapse decreases with time in patients who are stabilized. Many treatment guidelines recommend that after stabilization, antipsychotic treatment should be continued for 1-5 years, and longer exposure should be avoided if possible. However, there is no published evidence to substantiate this view. The authors used nationwide databases to investigate this issue.
Prospectively gathered nationwide register data were used to study the risk of treatment failure (psychiatric rehospitalization or death) after discontinuation of antipsychotic treatment. Multivariate Cox regression was used to assess outcomes among all patients hospitalized for the first time with a schizophrenia diagnosis in Finland during the period of 1996-2014 (N=8,719).
The lowest risk of rehospitalization or death was observed for patients who received antipsychotic treatment continuously (adjusted hazard ratio=1.00), followed by patients who discontinued antipsychotic use immediately after discharge from the first hospital treatment (hazard ratio=1.63, 95% CI=1.52-1.75), within 1 year (hazard ratio=1.88, 95% CI=1.57-2.24), within 1-2 years (hazard ratio=2.12, 95% CI=1.43-3.14), within 2-5 years (hazard ratio=3.26, 95% CI=2.07-5.13), and after 5 years (a median of 7.9 years) (hazard ratio=7.28, 95% CI=2.78-19.05). Risk of death was 174%-214% higher among nonusers and patients with early discontinuation of antipsychotics compared with patients who received antipsychotic treatment continuously for up to 16.4 years.
Whatever the underlying mechanisms, these results provide evidence that, contrary to general belief, the risk of treatment failure or relapse after discontinuation of antipsychotic use does not decrease as a function of time during the first 8 years of illness, and that long-term antipsychotic treatment is associated with increased survival.
一般认为，精神分裂症首次发作后，在病情稳定的患者中，随着时间的推移，复发的风险会降低。许多治疗指南建议，在病情稳定后，应继续使用抗精神病药物治疗 1-5 年，如果可能的话，应避免长期暴露。然而，目前还没有发表的证据来证实这一观点。作者利用全国性数据库对此问题进行了研究。
使用前瞻性收集的全国性登记数据，研究抗精神病药物治疗停止后治疗失败（精神科再住院或死亡）的风险。多变量 Cox 回归用于评估芬兰在 1996-2014 年期间首次因精神分裂症住院的所有患者的结局（n=8719）。
接受抗精神病药物连续治疗的患者再住院或死亡风险最低（调整后的风险比=1.00），其次是在首次住院治疗出院后立即停止使用抗精神病药物的患者（风险比=1.63，95%CI=1.52-1.75）、在 1 年内（风险比=1.88，95%CI=1.57-2.24）、1-2 年内（风险比=2.12，95%CI=1.43-3.14）、2-5 年内（风险比=3.26，95%CI=2.07-5.13）和 5 年后（中位数为 7.9 年）（风险比=7.28，95%CI=2.78-19.05）。与连续使用抗精神病药物治疗长达 16.4 年的患者相比，非使用者和早期停药的患者死亡风险高 174%-214%。
无论潜在机制如何，这些结果都提供了证据，表明与普遍看法相反，在疾病的头 8 年内，停止使用抗精神病药物后治疗失败或复发的风险并不会随着时间的推移而降低，并且长期使用抗精神病药物与生存获益相关。
